Wellness Evaluation | BioEnergetic Therapeutics

BioEnergetic Therapeutics

Personal Wellness Evaluation

Your evaluation starts the teamwork for building the best tailored session for you!
Immediately benefit a greater life balance when you submit your thoughtful pre-assessment of stress as your brain sorts it out and reorganizes information.
There are no wrong answers! Write about what prompted you to schedule your upcoming appointment. Think about what feels out of sync in your life and why.
An advanced submission of 2 days prior to your consultation or at your earliest time is appreciated.
For best results, please login to avoid losing your information.

Client's Full Name

Email Address

Mobile

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

Date of Birth

Parents' Name (If Client Is Child)

New Clients: Who referred you?

NEW CLIENTS ONLY: Please share any family history, surgeries or medication that is relevant to your wellbeing.

NEW CLIENTS ONLY: Please share a little history about your wellness. How long have you been suffering with the problems listed and have you noticed anything getting worse (more intense, frequent or long-standing)?

What are your symptoms and current stress that disrupts your balance and wellbeing? If this is a follow-up, please consult your session notes, if possible, to update how you are doing in relation to your current body of work. Additionally, you may share anything new that might have manifested between sessions.

What details of life do you believe or suspect that could be contributing to your symptoms and current stress?

Why is it that the symptoms and current stress are more difficult to manage than other problems you face or have faced in life? In other words, please try to isolate why you have decided to schedule a session by evaluating whether it has been preventing or challenging certain areas of life and functioning. Remember to mention how it is impacting the quality of your life.

Please give a brief description of your stress and symptom in terms of how it affects you. This could be an influence in one or all areas of functioning: physically, mentally, emotionally or spiritually. (You may choose either to comment on the area that is most affected or relate how it feels in each aspect.)

How do or could you connect your current stress with occurrences or patterns from your past? Please comment on how this has been a recurring theme or problem and why. Try to think about a possible reason that this type of problem may particularly trouble you over the course of your life.

How do you imagine your life or wellbeing if these problems could be eliminated, reduced or managed? In relation to your stress, how would you realistically, yet a bit ideally, want your life to be?

Please mention any other practices utilized to help your wellbeing. Please evaluate what you feel is working or not concerning your nutritional, supplemental and other complementary therapies or medical procedures.

Anything else not covered in this evaluation that you would like to share that is important to your wellness?

VIBRATIONAL TOOLS/PHARMACY: Please update any vibrational tools that you have on hand that might could be used for your session, e.g. essential oils, flower or gem essences, homeopathics, color therapy, BEMER, tuning forks, etc. You may upload a document or share a file in Apple Notes or Google Docs, if you prefer.

Please upload a relevant file, such as recent labs here. If more than one, please bundle them into a single PDF prior to uploading.

Upload Documents

Please upload any relevant phots of symptoms or documents here.

Upload Pictures

Please subscribe me to occasional mailings and updates

Thanks for submitting!

Shelly Early

Wellness Consultant

Providing An Alternative Approach To Healing

BioEnergetic Therapeutics

Personal Wellness Evaluation

Shelly Early
BioEnergetic Therapeutics Specialist
info@shellyearly.com